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Portosystemic shunt

Jamie RiChard, Bartley Thornburg
Recently, new techniques and devices in transjugular intrahepatic portosystemic shunt (TIPS) placement have emerged that can improve upon the standard procedure. Ultrasound guidance during TIPS with intracardiac echocardiography (ICE), placement of controlled expansion (CX) stents, and portal vein recanalization (PVR) via transsplenic access are three techniques with new data supporting their implementation. ICE guidance can improve the technical success of difficult cases, decrease procedure time, and decrease complications such as capsular puncture, hemobilia, and hepatic artery injury...
August 2018: Seminars in Interventional Radiology
Michelle Philip, Bartley Thornburg
Extrahepatic abdominal surgery in patients with portal hypertension is associated with a high rate of perioperative complications and death due to the increased risk of liver failure, perioperative bleeding, and ascites. One proposed method to facilitate surgery in these patients is with preoperative placement of a transjugular intrahepatic portosystemic shunt (TIPS). By decompressing the portal circulation, this presurgical measure would theoretically decrease the potential for bleeding and improve the ability to control ascites in the perioperative and postoperative period...
August 2018: Seminars in Interventional Radiology
Joseph Chmielewski, Robert J Lewandowski, Haripriya Maddur
Individuals with end-stage liver disease are susceptible to a myriad of highly morbid complications, including hepatorenal syndrome (HRS). This specific type of renal dysfunction in patients with underlying liver disease occurs in pathophysiologically normal kidneys and is a result of renal vasoconstriction secondary to diminished renal blood flow in the setting of worsening hepatic dysfunction. Liver transplantation is curative; shortage of available organs limits access to this beneficial therapy. Medical management of HRS has demonstrated increasing promise...
August 2018: Seminars in Interventional Radiology
Mihir Patel, Christopher Molvar
Gastric variceal hemorrhage is a life-threatening complication of portal hypertension with a poorer prognosis compared with esophageal variceal hemorrhage. The presence of an infradiaphragmatic portosystemic shunt, often a gastrorenal shunt, allows for treatment with retrograde transvenous obliteration (RTO). RTO is an evolving treatment strategy, which includes balloon-assisted RTO, plug-assisted RTO, and coil-assisted RTO, for both gastric variceal hemorrhage and hepatic encephalopathy. RTO techniques are less invasive than transjugular intrahepatic portosystemic shunt creation, with the benefit of improved hepatic function, but at the expense of increased portal pressure...
August 2018: Seminars in Interventional Radiology
Andrew J Lipnik, Mithil B Pandhi, Ramzy C Khabbaz, Ron C Gaba
Variceal hemorrhage is a feared complication of portal hypertension, with high rates of morbidity and mortality. Optimal management requires a thoughtful, multidisciplinary approach. In cases of refractory or recurrent esophageal hemorrhage, endovascular approaches such as transjugular intrahepatic portosystemic shunt (TIPS) have a well-defined role. For hemorrhage related to gastric varices, the optimal treatment remains to be established; however, there is increasing adoption of balloon-occluded retrograde transvenous obliteration (BRTO)...
August 2018: Seminars in Interventional Radiology
Ana Cecilia Burgos, Bartley Thornburg
Ascites is the most common complication of cirrhosis, impairs quality of life, and carries a poor prognosis. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated therapy for refractory ascites and is superior at reducing the accumulation of fluid compared with paracentesis. More recent evidence has shown that TIPS also provides an improved transplant-free survival compared with paracentesis. To maximize the clinical efficacy and survival advantage, proper patient selection is crucial. While current guidelines recommend that elective TIPS for ascites should be performed only in patients with MELD ≤ 18, recent literature suggests that elective TIPS safely and effectively controls ascites and potentially provides a survival advantage in patients with higher MELD scores (≤ 24)...
August 2018: Seminars in Interventional Radiology
Victoria Young, Shankar Rajeswaran
Interventional radiology's role in the management of portal hypertension in the pediatric population differs from the management of adult portal hypertension. In the pediatric population, portal hypertension is frequently secondary to thrombosis and cavernous transformation of the extrahepatic portion of the portal vein. Transjugular intrahepatic portosystemic shunt can be utilized to manage portal hypertension in children with intrinsic liver disease that results in cirrhosis and portal hypertension, and is often used as a bridge to transplant...
August 2018: Seminars in Interventional Radiology
Paloma Triana Junco, Ana Alvarez, Mariela Dore, Javier Jimenez Gomez, Alba Sánchez Galán, Alejandra Vilanova-Sánchez, Ane Andres, Jose Luis Encinas, Leopoldo Martinez, Francisco Hernandez, Manuel Lopez Santamaria
AIM:  Extrahepatic portal vein obstruction (EHPVO) is a frequent cause of noncirrhotic portal hypertension in children. The aim of this study is to analyze long-term results after diversion surgery. PATIENTS AND METHODS:  Retrospective review of EHPVO patients who underwent diversion surgery analyzing number of platelets, leukocytes, prothrombin activity, splenomegaly, and gastrointestinal bleeding 10 years after surgery. RESULTS:  Thirty-three patients were evaluated, mostly males (64%) and presenting with gastrointestinal bleeding (46%)...
August 7, 2018: European Journal of Pediatric Surgery
Aichi Chien, Yun-Lia Wang, Justin McWilliams, Edward Lee, Stephen Kee
OBJECTIVE: The purpose of this study was to investigate a new method-the portal vein enhancement curve-for quantifying portal vein blood flow immediately at transjugular intrahepatic portosystemic shunt (TIPS) creation using digital subtraction angiography images and its potential usefulness as a predictor of TIPS revision. CONCLUSION: The portal vein flow time constant, Qτ , was significantly different (p = 0.002) between patients grouped by 12-month revision (TIPS angioplasty, TIPS reduction, no revision); Qτ was higher in patients who required TIPS reduction...
August 7, 2018: AJR. American Journal of Roentgenology
Rhiannon Strickland, Michael S Tivers, Sophie E Adamantos, Tom R Harcourt-Brown, Robert C Fowkes, Victoria J Lipscomb
OBJECTIVE: To determine the incidence, outcome, and risk factors for postattenuation neurological signs (PANS) and seizures after attenuation of single congenital portosystemic shunts (CPSS) in dogs. STUDY DESIGN: Retrospective cohort study. SAMPLE POPULATION: Dogs (N = 253) with single CPSS. METHODS: Medical records of dogs treated by surgical attenuation of a single CPSS between February 2000 and July 2015 were reviewed for signalment and preoperative and postoperative clinical outcomes, including the occurrence of PANS...
August 7, 2018: Veterinary Surgery: VS
Jin-Shan Zhang, Long Li, Wei Cheng, Wen-Ying Hou
PURPOSE: Ligation of abnormal portosystemic shunt has been used to treat type II Abernethy malformation, but it may not be suitable for all of patients. In this study, Rex shunt were carried out to manage type II Abernethy malformation with portal venous dysplasia. The outcomes are evaluated retrospectively. METHODS: Between Jun 2014 and Jan 2015, two boys (age: 4.8 and 12.8 years respectively) with type II Abernethy malformation underwent Rex shunt with ligation of inferior mesenteric vein (IMV)...
August 3, 2018: Annals of Vascular Surgery
Hong-Bin Li, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Xiao-Qun Dong, Fu-Quan Liu
Background: Post-TIPS hepatic encephalopathy (PSE) is a complex process involving numerous risk factors; the root cause is unclear, but an elevation of blood ammonia due to portosystemic shunt and metabolic disorders in hepatocytes has been proposed as an important risk factor. Aims: The aim of this study was to investigate the impact of pathological features of mitochondrial ultrastructure on PSE via transjugular liver biopsy at TIPS implantation. Methods: We evaluated the pathological damage of mitochondrial ultrastructure on recruited patients by the Flameng classification system...
2018: Canadian Journal of Gastroenterology & Hepatology
Long-Biao Cui, Shuyao Ren, Yi-Bin Xi, Ling-Li Zeng, Gang Chen, Kang Liu, Tianlei Yu, Chuangye He, Wengang Guo, Zhanxin Yin, Zhengyu Wang, Jing Niu, Bohan Luo, Dewen Hu, Guohong Han, Hong Yin
RATIONALE AND OBJECTIVES: As a special movement disorder, hepatic myelopathy (HM) is characterized by spastic paraperesis and may be secondary to transjugular intrahepatic portosystemic shunt (TIPS). The prediction and diagnosis of HM is difficult due to largely unknown neuropathological underpinnings and a lack of specific biomarkers. We aimed to delve into the alterations in motor system of HM patients' brain and their potential clinical implication. MATERIAL AND METHODS: Twenty-three patients with HM and 23 without HM after TIPS and 24 demographically matched healthy controls were enrolled...
August 1, 2018: Academic Radiology
Nelson Valentin, Praneet Korrapati, Joseph Constantino, Ari Young, Ilan Weisberg
BACKGROUND: The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal vein thrombosis (PVT) remains controversial. This study aimed to conduct a systematic review and meta-analysis to evaluate the role of TIPS for the management of PVT in adult patients with liver disease. PATIENTS AND METHODS: Multiple databases were searched through April 2017. Data were gathered to estimate the rates of technical success, portal vein recanalization, portal patency, hepatic encephalopathy, and mean change in portal pressure gradient in patients with PVT who underwent TIPS...
August 1, 2018: European Journal of Gastroenterology & Hepatology
Chikwendu J Ede, Dimitrinka Nikolova, Martin Brand
BACKGROUND: Hepatosplenic schistosomiasis is an important cause of variceal bleeding in low-income countries. Randomised clinical trials have evaluated the outcomes of two categories of surgical interventions, shunts and devascularisation procedures, for the prevention of variceal rebleeding in people with hepatosplenic schistosomiasis. The comparative overall benefits and harms of these two interventions are unclear. OBJECTIVES: To assess the benefits and harms of surgical portosystemic shunts versus oesophagogastric devascularisation procedures for the prevention of variceal rebleeding in people with hepatosplenic schistosomiasis...
August 3, 2018: Cochrane Database of Systematic Reviews
Roberto Miraglia, Luigi Maruzzelli, Ambra Di Piazza, Giuseppe Mamone, Settimo Caruso, Giovanni Gentile, Fabio Tuzzolino, Gaetano Floridia, Ioannis Petridis, Riccardo Volpes, Angelo Luca
OBJECTIVES: To evaluate short-term clinical efficacy, complications and possible passive stent expansion of transjugular intrahepatic portosystemic shunt (TIPS) creation using the new controlled expansion ePTFE covered stent (VCX), for portal hypertension complications. METHODS: Between 7/2016 and 3/2018, 75 patients received TIPS using VCX. Thirty-nine patients with VCX dilated with an 8-mm angioplasty balloon underwent computed tomography (CT) study during follow-up and CT data were used to measure stent diameter...
August 2, 2018: Cardiovascular and Interventional Radiology
Aida Suárez Sánchez, Lorena Solar García, Carmen María García Bernardo, Alberto Miyar de León
We report the case of a 29-year-old patient who presented with a short history of lower gastrointestinal bleeding. A diagnosis of Abernethy syndrome was made (congenital extrahepatic portosystemic shunt) after this uncommon clinical presentation. The prevalence of this congenital malformation is very low and usually manifests during the pediatric age, according to previously published reports.
July 31, 2018: Revista Española de Enfermedades Digestivas
Laurens Hermie, Elisabeth Dhondt, Peter Vanlangenhove, Eric Hoste, Anja Geerts, Luc Defreyne
OBJECTIVE: To evaluate the outcome of early transjugular portosystemic shunt (TIPS) treatment in patients with a trial-compatible high-risk variceal bleeding and secondly to disclose other predictors of early mortality. MATERIALS AND METHODS: A cohort study was conducted on patients referred for a TIPS procedure with or without combined variceal embolization to control acute esophageal variceal bleeding. A total of 32 patients with Child-Pugh C score less than 14 or Child-Pugh B plus active bleeding at endoscopy, admitted for early-TIPS treatment (<72 h), were included...
July 25, 2018: European Journal of Gastroenterology & Hepatology
Holger Strunk, Milka Marinova
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt created using endovascular techniques. During recent years technical improvements and new insights into pathophysiology have modified indications for TIPS placement. In this article we therefore want to discuss current knowledge. METHOD: A literature review was performed to review and discuss the pathophysiology, indications and results of the TIPS procedure. RESULTS: Established TIPS indications are persistent bleeding despite combined pharmacological and endoscopic therapy and rebleeding during the first five days...
August 2018: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Jiaze Yu, Xiaoze Wang, Mingshan Jiang, Huaiyuan Ma, Zilin Zhou, Li Yang, Xiao Li
OBJECTIVES: To assess the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with and without adjunctive embolisation in managing cardiofundal varices bleeding. METHODS: The retrospective study comprised 82 patients (54 men; mean age 53.9 years; mean Model of End-stage Liver Disease score 9.3) with cardiofundal varices bleeding who underwent TIPS creation from 2011 to 2015. Variceal rebleeding, the outflow tracts of varices, overt hepatic encephalopathy (HE) and post-procedure varices patency were assessed...
July 23, 2018: European Radiology
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